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HomeMy WebLinkAbout03-30-11 (2)r 1505,10142 REV-1500 ~x ~o~-lo, , . OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year DEPARTMENT OF REVENUE Bureau of Individual Taxes INHERITANCE TAX RETURN ~~,, PO Box 280601 RESIDENT DECEDENT `~ ~ ~ V Harrisburg, PA 1yi28-o6oi ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 162.22.3537 04082010 02191927 Decedent's Last Name Suffix Decedent's First Name ARMSTRONG KATHLEEN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI A MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return Q 2. Supplemental Return Q 3. Remainder Return (date of death prior to 12-13-82) Q 4. Limited Estate Q 4a. Future Interest Compromise (date of Q 5. Federal Estate Tax Retum Required death after 12-12-82) Q 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust 8. Total Number oaf Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (date of death Q 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD SE DIRECTED TO: Name Daytime Telephone Number FRANK H KELLY, EA 717.774.7536 First line of address 400 BRIDGE STREET, SUITE #4 Second line of address City or Post Office NEW CUMBERLAND Correspondent's a-mail address: State ZIP Code PA 17070 REGISTER OF~j(DILLS USE OWN ti) `-~ _ f D D FILE ;;r~ ~._ Und r penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, ~t ~s rue, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. I TU ~F PERSON RESP LE FOR FIIEF~JG RE (DATE ADDRESS U H LA D VE, ENOLA, PA 17025 SIG O REPARER OTHER THAN REPRESENTATIVE DATE C~BRIDGE STREET,_SUITE #4, NEW CUMBERLAND, PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610142 1505610142 File Number -~ ~~ ~ r"-j J ~~ I-t" ~ J ~-~r 150561Q242 ..~ REV-1500 EX Decedent's Name: KATHLEEN A ARMSTRONG Decedent's Social Security Number 162.22.3537 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 131 , 9 0 0 . 0 0 2. Stocks and Bonds (Schedule B) ....................................... 2. • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 8 ~ ~ • 0 ~ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 1 , 6 8 6.9 5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 7 0 0 0 (Schedule G) O Separate Billing Requested........ . • 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 13 4 , 3 8 6.9 5 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. :7 7 , 9 5 0.0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. .14 , 6 2 0 . 0 0 11. Total Deductions (total Lines 9 and 10) ................................. 11. ~4 2 , 5 7 0 • 0 0 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. :~ 1 , 816.9 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. '91, 816.9 5 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ . 15. 16. Amount of Line 14 taxable at lineal rate X .0 4 5 91, 817 • 16. 17. Amount of Line 14 taxable at sibling rate X .12 • 17. 18. Amount of Line 14 taxable at collateral rate X .15 • 18. 19. TAX DUE .................................................... .....19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 4, 131.77 4, 131.77 O Side 2 150561242 1505610242 REV 1500 EX Page 3 ~___~_._a~w ~A~\1\MIATA Arlrlrn~~~ File Number 21.10.0 4 31 DECEDENT'S NAME g _ ___ __ n Kathleen Armstro _ _ STREET ADDRESS 20 Sussex Road -- CITY -- STATE ZIP 17011 Camp Hill PA Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) 4,131.77 0.00 4,131.77 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No .................................... x a. retain the use or income of the property transferred :...................................................... ^ ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ ^x c. retain a reversionary interest; or .......................................................................................................................... ^ 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ ^x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 0 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ 0 ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for thie use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (01-10) `~ pennsylvan~a SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.043:L All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1504 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 Schedule C-1 or C-2 (including all supporting information) must be attached for each closet'-held corporationlpartnershipinterest ofthe decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV 1505 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 1. Name of Corporation None State of Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2. Federal Employer I.D. Number Business Reporting Year _ 3. Type of Business Product/Service 4 6. Was the Corporation indebted to the decedent? ......................................... Yes ~ No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ............ ~ Yes ~ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer any stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? Yes ~ No If yes, Transfer Sale Number of Shares Transferee or Purchaser Consideration $ Attach a separate sheet for additional transfers and/or sales. Date 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....... ~ Yes ~ No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ...................................................... Yes ~No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? ...................... Yes ~ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? .................... Yes ~ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? ........................................ Yes ~ No If yes, Position Annual Salary $ Time Devoted to Business . REV 1506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 1. Name of Partnership None Date Business Commenced . Address Business Reporting Year City State Zip Code 2. Federal Employer I.D. Number 3. Type of Business Product/Service 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. 7. Was the Partnership indebted to the decedent? ......................................... ^Yes ^ No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ............ ^Yes ^No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^Yes ^No If yes, ^Transfer ^Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ......... ^Yes ^No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? .......................................... ^Yes ^No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ...................... ^Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ........................................ ^Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .................... ^Yes ^No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • •~ ~ • ~ ~ A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. 6. Value of the decedent's interest $ ` REV-1507 EX+ (6-98) SCHEDULE D MORTGAGES & NOTES COM NHERV ITANCE TAX RETURNANIA RECEIVABLE RESIDENT DECEDENT __ ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV 1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) • REV 1509 EX+ (01-10) w.. ~ ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINTTENANT(S) NAME ADDRESS RELATIONSHIPTO DECEDENT A. None B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °,fi OF DECEDENTS INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST ~. A. 05241977 Members 1st FCU 19342.00 1,964 6.67 327.40 2. B 12061984 Members 1st FCU 19342.11 1,575 6.67 262.55 3. C 07032003 Members 1st FCU 172459.40 1,189 50. 594.50 4. D. 07032003 Members 1st FCU 148241.40 1,005 50. 502.50 TOTAL (Also enter on line 6, Recapitulation) ~ 1 , 6 8 6 . 9 5 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (08-09) ~~~ ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV 1500 COVER SHEET is yes. ITEM NUMBER DESGRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OFASSET °!° OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. Life Insurance Policies that are not subject to PA probate or Inheritence taxes - beneficaries named on policies 0 0 0 0.00 TOTAL (Also enter on line 7, Recapitulation} 1 ~ _ 0 . 0 0 (1f more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) ~ pennsylvan~a DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ Musselmans Funeral Home, Lemoyne, PA 5,373 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant StreetAddress 4. 5. s. ~. 8. 9. City State ZIP Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Selling Costs on Home - see settlement sheet Patroit News Death Notice Kelly Financial Services Inheritance Tax Prep 415 262 575 17,335 630 3,360 TOTAL (Also enter on line 9, Recapitulation) I ~ 2 7 , 9 5 0 . 0 0 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH i. American Express 563 2. Apria 125 3. Dr. Aziz Khan 156 4. Boscovs Credit Card 516 5. Cardio Vascular Surgeons 19 6. Center for Disease 9 7. Center for Kidney 384 8. Central PA Polumonary 82 9. Chase Credit Card 652 10. Dr. Craif Anderson 330 11. C W Fritz 503 12. Dish Network 43 13. Erie Insurance 452 14. Heritage Medical 453 15. Holy Spirit Hospital 1,231 16. Home Paramount Pest Control 869 17. Internist of Central PA 30 18. Lower Allen TWP Taxes 1,966 19. Lung Asthma 111 20. PA American Water 148 21. PPL 346 22. UGI 259 23. Verizon 32 24. Visa Credit Card 6,917 25. West Shore EMS 394 26. West Shore Pathology 38 27. Mobile X-Ray 2 28. OGI 15 29. OIP 6 30. Prism 68 31. Quantum 166 32. Various refunds for services (2,271) 33. Smith Radiology 6 TOTAL (Also enter on Line 10, Recapitulation) ~ $ If more space is needed, insert additional sheets of the same size. 14, 620.00 . REV-1513 EX+ (11-08) pennsylvan~a DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] i. Gretchen Shuman Grand Daughter 1/3 Mechanicsburg, PA 2. Gwendloyn Phelps Grand Daughter 1/3 Enola, PA 17025 3. Gloria Phelps Daughter 1/3 Middletown, PA II ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TQTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I ~ If more space is needed, insert additional sheets of the same size. REV-1514 EX+ (4-09) ~ Pennsylvania DEPARTMENT OF REVENUE Bureau of Individual Taxes PO Box 280601 Harrisburg PA i'ji28-0601 SCi~IEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (CHECK BOX 4 ON REV-s5oo COVER SHEET) ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to the tax. return. ® Will ^ Intervivos Deed of Trust ^ Other NAME of LIFE TENANT . DATE. of BIRTH ~ NEAR~T A~ AT `DATE ?ft DIEATH TEIRM OF YEARS LIFE 1~3TATE!' IS RAYABLE ^ Life or ^ Term of Years ^ Life or [] Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable .........................................$ 2. Actuarial factor per appropriate table ............................................... . Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate 3. Value of life estate (Line i multiplied by Line 2) ....................................$ NAME of LIFE ANNUITANT DATE''oF BIRTH NIFARI~S'I" A811+ AT DATE'`OF DEATW TARN oll: YfAIS ANNUITY IS PAYABIE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ...........................................$ 2. Check appropriate block below and enter corresponding number ................ . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. . 5. Annuity Factor (see instructions) Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (See instructions.) ................................................ . 7. Value of annuity - If using 3.5, 6, or 10%, or if variable rate and period payout is at end of period, calculation is Line 4 x Line 5 x Line 6 ...........................$ If using variable rate and period payout is at beginning of period, calculation is (Line 4 x Line 5 x Line 6) + Line 3 ...............................................$ NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. If more space is needed, use additional sheets of the same size. REV-1644 EX+ (01-10) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE L REMAINDER PREPAYMENT OR INVASION OF TRUST CORPUS I. ESTATE OF Kathleen A Armstro FILE NUMBER 21.10.0431 This schedule is appropriate only for estates of decedents dying on or before Dec. 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust corpus (principal). II. REMAINDER PREPAYMENT: A. Election to Prepay Filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income or Annuitant(s) of Election or Annuity is Payable C. Assets: Complete Schedule L-1 1. Real Estate ........................... $ 2. Stocks and Bonds ...................... $ 3. Closely Held Stock/Partnership ............. $ 4. Mortgages and Notes .................... $ 5. Cash/Misc. Personal Property .............. $ 6. Total from Schedule L-1 .................. ............................$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities ....................... $ 2. Unpaid Bequests ....................... $ 3. Value of Non Includable Assets ............. $ 4. Total from Schedule L-2 .................. ............................$ E. Total Value of Trust Assets (Line C-6 minus Line D-4 ) ...........................$ F. Remainder Factor ........................ ........................... . G. Taxable Remainder Value (Multiply Line E by Line F) ............................$ (Also enter on Line 7, Recapitulation) III. (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income or Annuitant(s) Corpus or .Annuity is Payable Consumed INVASION OF CORPUS: A. Invasion of Corpus C. Corpus Consumed ....................................................$ D. Remainder Factor ................................................... . E. Taxable Value of Corpus Consumed (Multiply Line C by Line D) ....................$ (Also enter on Line 7, Recapitulation) REV-1645 EX+ (11-09) "`~`~~~ Pennsylvania INHERITANCE TAX SCHEDULE L-1 DEPARTMENT OF REVENUE INHERITANCETAxRETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- I. ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 II. ITEM NO. DESCRIPTION VALUE A. Real Estate (Please describe.) None Total Value of Real Estate $ (Include on Section II, Line C-1 on Schedule L.) B. Stocks and Bonds (Please list.) Total Value of Stocks and Bonds $ (Include on Section II, Line C-2 on Schedule L.) C. Closely Held Stock/Partnership -Please list. (Attach Schedule C-1 and/or C-2.) Total Value of Closely Held/Partnership $ (Include on Section II, Line C-3 on Schedule L.) D. Mortgages and Notes (Please list.) Total Value of Mortgages and Notes $ (Include on Section II, Line C-4 on Schedule L.) E. Cash and Miscellaneous Personal Property (Please list.) Total Value of Cash/Miscellaneous Personal Property $ (Include on Section II, Line C-5 on Schedule L.) [II. TOTAL (Also enter on Section II, Line C-6 on Schedule L.) $ If more space is needed, attach additional sheets of paper of the same size. . REV-1646 EX+ (11-09) ~~~~~~ pennsyLvania INHERITANCE TAX SCHEDULE L- 2 DEPARTMENT OF REVENUE INHERItANCETAxRETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -CREDITS- I. ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 II. ITEM NO. DESCRIPTION AMOUNT A. Unpaid Liabilities Claimed against Original Estate and Payable from Assets Reported on Schedule L-1 (please list) None Total Unpaid Liabilities $ (include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Bequests $ (include on Section II, Line D-2 on Schedule L) C. Value of Assets Reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are Not Included for Tax Purposes or that Do Not Form a Part of the Trust. Calculation as follows: Total Non Includable Assets $ (include on Section II, Line D-3 on Schedule L) tII. TOTAL (Also enter on Section II, Line D-4 on Schedule L) $ If more space is needed, attach additional sheets of paper of the same size. • REV 1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1500 Cover Sheet ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. II. III. Beneficiaries NAME OF BENEFICIARY REL~ITIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. None 2. 3. 4. 5. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest ...................................................... $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) .. $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ^ 6%, ^ 3%, ^ 0% .................. $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% ........................ $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) .. $ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) .. $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) .................. $ (If more space is needed, insert additional sheets of the same size) REV-1648 EX (02-09) SCHEDULE N '~`~. Pennsylvania SPOUSAL POVERTY CREDIT DEPARTMENT OF REVENUE Bureau of Individual Taxes PO Bax 280601 FOR DATES OF DEATH 01/01/92 TO 12/31/94 Harrisbur PA i~i28 ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.0431 This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. 1 . Taxable assets total from Line 8 (cover sheet) .............................................. 1 . 0 2. Insurance proceeds on life of decedent ................................................... 2. 3. Retirement benefits ................................................................. 3. 4. Joint assets with spouse .............................................................. 4. 5. PA Lottery winnings .................................. .............................. 5. ..; ,y ` 6a. Other nontaxable assets: List and attach schedule if necessary .. 6a. $ ~~.. ' ) ~£v 5$ 6b. ~, r~ . 6c. ~; ~, ~ • , ~ ~ ~E t: ~ ~~~ 6d. 6. SUBTOTAL (Lines 6a, b, c, d) .......................................................... 6. 0 . 0 0 7. Total gross assets (Add Lines 1 thru 6) ................................................... 7. 0 . 0 0 8. Total actual liabilities ................................................................ 8. 9. Net value of estate (Subtract Line 8 from Line 7) ............................................ 9. If Line 9 is greater than $200,000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part IL 0 . 0 0 Income: 11. I TAX YEAR: 19 a. Spouse ............ 1a. b. Decedent .......... 1b. c. ]oint ............ . ic. d. Tax-exempt income .... ld. e Other income not listed above ........ 1e. f. Total ............. if. 4. Average joint exemption income calculation 4a. Add joint exemption income from above: (1f) + (2f) _ 2. 1 TAX YEAR: 19 2b. 2c. 2d. 2e. 2f. + (3f) 3. I TAX YEAR: 19 3a. 3b. 3ci 3d. 3e. 3f. ~- 3 4b. Average joint exemption income ........................................................ _ If line 4ib) is greater than $40,000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part III. i. Insert amount of taxable transfers to spouse or $100,000, whichever is less ........................ ~ 1. 2. Multiply by credit percentage (see instructions) .............................................. 2 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet . ................................ 3. 4. For nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate .................................................... 4. 5. Multiply Line 3 by Line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet........... 5• • REV-1649 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER Kathleen A Armstrong 21.10.04:31 Do not com plete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the None Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedents surviving spouse ~~~ II~vIG .IFIGNG W IIGGU~iY, 111~7G~1 GYU1lIVllp1 JIIGGW VI 1116 JGIIIG JILL) a1''~ T ~4 0 ~ ' ~ A. Settlement Statement (HUD-1) ^ ~O 4; G,p ~N DlJt T_... .t 1 ~~.~ OMB Approval No. 2802-0285 1. ~ FHA 2. Q RHS 3. Q Conv. Unlns. 4. ®VA 5. Q Conv. Ins. 6. Fib Number: 10374 7. Loan Number: 1030820077 8. Mortgage Insurance Case Number: 10-10.6-0615868 C. Note: This form !s famished to give you a statement of sctus! settbment costs. Amounts pat to end by the settlement agent are shown. Items marked "(p. o. c. j `were paid outside the dosing; they are shown hero for infbrmationa/ purposes and are not irrdutisd !n the totals. D. Name and Addross of Borrower: Robert J. Semanick 2311 North Front Street, Apt. 213 Harrisburg, PA 17110 E. Name end Addross of Seller: Estate of Kathleen A. Armstrong 20 Susses Road Camp Hill, PA 17011 F. Name and Addross of Lender: Florida Capital Bank NA DBA Florida Capital Bank Mortgage 4815 Executive Psrk Court, Ste. 103 Jacksonville, FL 32218 G. Property Location: 20 Sussex Road Camp Hill, PA 17011 Cumberland County, Pennsylvania H. Settlement Agent: 25-1878915 Keystone Land Transfer, Ltd. 3421 Market Street Camp Hill, PA 17011 Ph. (717)731-4200 1. Seribment Date: Novemtxr 22, 2010 Piece of Seribment: 3421 Market Stroet Cam Hill, PA 17011 J. Summa of Borrower's transaction K. Summa of Saber's tnnsactlon 100. Gross Amount Ow from Borrower: 400. Gross Amount Due to Selbr. i01. CoMrad sobs rice 131 900.00 401. Contrail eats rice 131 900.00 102. Personal 402. Personal 103. Settbment Cha s to Borrower Line 1400 8 100.19 403. 104. 404. 105. 405. Ad wtmsnb for Ibms id Salter In advanu Ad wtmanb for Ibms id Seller in advance 106. C down Taxes to 408. C /Town Taxes to 107. Coun Taxes 11!22/10 to 01/01/11 62.82 407. Coun Taxes 11/22/10 to 01/01/11 62.82 108. School lax 11/22/10 to 07!01111 852.03 408. School Tax 1122/10 to 07/01/11 652.03 109. Sewer 4 Trash 1122/10 to 01101/11 42.59 409. Sewer S Trash 1122/10 to 01/01/11 42.59 110. 410. 111. 411. 112. 412. 120. Gross Amount Dw from 8orrovwr 140,757.63 420. Gross Amount Dw to Salter 132,857.44 200. Amount Pald or In B~haN of Borrovwr b00. Reductions in Amount Dua Seller. 201. De it or ssmest mono 1 000.00 501. Excess d it see instrudbns 202. Prin ' al amount of new loans 134 735.00 502. Settbmsnt cha s to Sslbr Une 1400 18 309.27 203. Existin loans taken sub' d to 503. Existin loans taken tub d to Y04, 504. Pa ff First Mort a to New Cumberland F.C.U./663 8,871.78 Y05, 505. Pa if Second Mort a e 206. Broker CrodiUUnailowabb VA 805.00 506. 207, 507. De osit diet, as roceeds 208, 508. 209. Selby Credit 5 276.00 509. Selby Credit 5 276.00 Ad ustmenb for ibms un id Ssltar Ad wtmsnb for flame un Id Sailer 210. C !Town Taxes to 510. C ITown Taxes to 211. Coun Taxes to 511. Coun Taxes to 212. School Tax to 512. School Tax to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid /for Borrower 141,816.00 520. Total Rsductfon Amount Dw Ssllsr 32,457.05 300. Cash at SstWmsnt trorrr/to Borrower 800. Cute at ssttJsmant tolfrom Seller 301. Gross amount due from Borrower line 120 140 757.63 601. Gross amount due to Selby line 420 132 657.44 302. Less amount akf /for Borrower line 220 ( 141,816.00) 602. Less redudions due Selby line 520 ( 32,457.05 303. Cash ~ From XD To Borrower 1,058.37 603. Cash a To ~ From Sallar 100,200.39 The undersigned heroby ac/k/n~o~wb~dge receipt of a compbted copy of this statement 8 any attachments roferrod to herein Borrower /%~~„y,L~~ ~'~~ Selby Es of Kathleen A. ng C~ c Robert J. manick V \V)~~~~ B. Th• Rtle R.Ponrq e~+wn ror lhb oolNetlan a r~romuuon l..,trrn.ud .k 3s Pw tar . ~~~W. •nd nportlrq ur dw. Thb ~pMwy m.r na aiNet tlw tKamWon, uw you w rwt rp~ird a Y1it tam, ~I11M! M MPMY! ~ v~Yd OMB mRVd rNrnDU. No mrMdrntl~My k aur~O; tlti! disdown i! muld~lOfy. Thu N d~WrMd b Proms tlM pulls b ~ RESPA eowrW uargkNOn vrNh fnlorrmtlon dufkq Mtn N/tlufreN ptonu. Page 1 of 3 HUD-1 (10374110374/40) L. Settlement Char es 700. Total Reai Estab Broker Fees $ 8,309.00 ..___ Paid From Paid From Division of commission line 700 as follows: t3ortowara weer. 701. 8 308.00 to Re/Max Rea A ciat s In . Fimda at Funds a 702. to Re/Max Reai sociat Inc. settleement ssttNrnent 703. Commis i n id a e l m n 8 09.C 704. Broker Fee to Re/Max Rea Associates Inc. 395.00 705. tsuu. ftem>s ravaots to t.:onna-cnon wt><n moan 801.Our origination charge $ 6,210.84 802. Your credit or charge (points) for the specific interest rate chosen $ -5,832.68 (from GFE #1) (from GFE #2) 803. Your adjusted origination cha rges (from GFE #A) 378.16 804. Appraisal fee to Foote Capital Mortgage Co. (from GFE #3) 475.00 805. Credit Report to Foote Capital Mortgage Company (from GFE #3) 29.74 806. Tax service to (from GFE #3) 807. Flood certffication to Florida Ca ital Bank, NA DBA Florida Ca its (from GFE #3 14.00 808. Home/PesURadon Ins to Mike Shee Home Ina actions from GFE #6 POC:B395.0 809. (from GFE #6) 810. (from GFE #3) 811. from GFE #3 901. Daily interest charges from 11/22/10 to 12/01/10 9 ~ $16.611200/day (from GFE #10) 149.50 902. Mortgage insurance premium for months to VA (from GFE #3) 2 835.85 903. Homeowner's insurance for 1.0 yeas to Allstate Insurance (from GFE #'1pf'1000076030715369 363.87 904. (from GFE #11) 905. (from GFE #11) 1000. Reserves Deposited with Lender 1001. Initial deposit for your escrow account ~.. ~_~ (from GFE #9) 632.32 omeowne s nsurance mont a per mont 1003. Mortgage insurance months @ $ per month $ 1004. Property taxes $ County Taxes months ~ $ per month Assessments months $ er month 1005. $ 1006. months t~ $ per month $ 1007. County Tax 10.000 months (~ $ 47.77 per month $ 477.70 1008. School Tax 6.000 months (83 $ 87.95 per month $ 527.70 1009. Aggregate Adjustment $ -464.04 1100. Title Charges 1101. Title services and lender's title insurance (from GFE ttP4) 1 353.75 1102. Settlement or closing fee $ 1103. Owners title insurance to First American Title Ins. Co. (from GFE #5) 1104. Lenders title insurance to First American Title Ins. Co. $ 1,183.75 1105. Lender's title oli limit $ 134 735.00 PAL#106924035 1106. Owner's title li limit $ 131 900.00 PAO#107237355 1107. A ant's onion of the total title insurance remium to Ke tone Land Transfer Ltd. $ 1 006.19 1108. Underwriter's portion of the total title insurance premium to First American Title Ins. Co. $ 177.56 1109. Note Fee to Vickie Walker 15.OC 1110. Tax Certification to Keystone Land Transfer, Ltd. 12.0C 1111. 1112. Overnight Fee to Keystone Land Transfer, Ltd. 14.OC 1113. Document Preparation to Keystone Land Transfer, Ltd. 125.OC ~ zuu. ~overnmentt rcecororng ana r ransrsr ~narges 1201. Government recordi cha es to Cumberland Coun Recorder of Deeds from GFE #7 154.00 1202. Deed $ 62.00 Mort a e $ 92.00 Releases $ Other $ 1203. Transfer taxes to Cumberland Count y Recorder of Deeds (from GFE #8) 1,319.00 1204. Ci /Coun tax/stamps Deed $ 1,319.00 Mortga e $ 1205. State tax/atamps Deed $ 1,319.00 Mortgage $ 1 319.OC 1206. 1207. »uv. Hav~uvna~ aeuaement ~narass 1301. Required services that you can shop for (from GFE #6) 1302. Plumbin 8 Electrical Bills to The New C. W. Fritz Com an Inv. Nos. 68298-683 710.2 i 1303. Escrow for Inheritance Taxes to Keystone Land Transfer, Ltd. 6,500.OC 1304. Home Warranty to American Home Shield #91010371 435.OC 1305. Radon Mil' ation to Homes ec Inv. #42 870.OC 1400. Total Settlement Charges (enbr on Tines 103, Section J and 502, Sectfon K) 8 100.19 18 309.2 ~ ay sprMny pays 1 or fhb statement, the :ignatortes ecla,owledye naipt d a completed copy or pays 2 a 3 or this Mxse pays atatemerq. Keystone Land Transfer, Ltd., Settlement Agent ~ f tNNJYLYANlA 1NFitK1 IANi:t IAR INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D PO BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP (0 fi- 00 ) GRETCHEN L SCHUMAN 600 EAST MAPLE STREET MECHANICSBURG PA 17055 FILE NO. 21 10-0431 ACN 1D125657 DATE 05-06-2010 TYPE OF ACCOUNT EST. OF KATHLEEN A ARMSTRONG ® SAVINGS SSN 162-22-3537 ~ CHECKING DATE OF DEATH 04-08-2010 ~ TRUS7 COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 MEMBERS 1ST F CU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attache a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the C',ommonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19342-00 Date 05-24-1977 To ensure prover credit to the account, two Established copies of this notice must accompam payment to the Register o~f Wills. Make check Account Balance $ 1 , 963.92 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to TaX $ 327 • 33 months of the decedent's (late of death, Tax Rate ~( . 045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due wiill become delinquent Potential Tax Due $ 14 • 73 nine months after the date of death. PART TAXPAYER RESPONSE A. ~ The above intormation and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenus~. ONE B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state ''''' relationship to decedent: y~~, TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS >~`~~ <::,,:. r..:... .... ,.. ..: LINE 1. Date Established 1 ~'~~ /~i~'~ . $ "<'s~~ 2. Account Balance 2 ~'`=F~ :: 3. Percent Taxable 3 X "jl~,s~ 4. Amount Subject to Tax 4 $ ,y„ ~` ~ 1 f~ ~~ J ~f~ ~~ a 5. Debts and Deductions 5 - ~>~, 'Y, 1 l 6. Amount Taxable 6 $ ~%r •:~~ ':.~'`: .~.~ ,% ~! 7. Tax Rate 7 X ?' f ~=~ ~-~ <`r,.•~..'.F','/, ~i ,.i:a ~';,r{%/,'ti: r~,>.,• ~ .r'£:;~ ~::::lrif:;:r~c>" ;,.;y .r,~;i;~~Jir,%r;' £.~.;::s?G /~,i, PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, corre<:t and complete to the best of my knowledge and belief. H O M E C ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S ;,~ PENNSYLVANIA INHERITANCE TAX .~ INFORMATION NOTICE BUREAU DF INDIVIDUAL TAXES AND ~i Po BOX 280601 TAXPAYER RESPONSE }IARiISBURG PA 17128-0601 REV-1543 EX AFP (08-00) ~~ GRETCHEN L SCHUMAN 600 EAST MAPLE STREET MECHANICSBURG PA 17055 FILE N0. 21 10-0431 ACN 10125657 DATE 05-06-2010 EST. OF KATHLEEN A ARMSTRON SSN 162-22-3537 DATE OF DEATH 04-08-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT (, ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Departsent with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-nased decedentr You were a ]oint owner/benefi.ciary of this account. If You feel the information is incorrect, please obtain written correction from the financial institution, attacF: a copy to this fors and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the [:ossonwealth of Pennsylvania. Please call C717) 787-8327 with questions. CDMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND. PAYMENT INSTRUCTIONS Account No. 19342-00 Date 05-24-1977 To ensure proper credit to the account, two Established copies of this notice lust accospany Account Balance $ 1 ~ Y6J • y~ payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax paysents aria lade within three Amount Subject to Tax $ 327 • 33 months of the decedent's date of death, TaX Rate X .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due wall becose delinquent Potential Tax Due $ 14 • 73 nine months after the date of death. PART TAXPAYER RESPONSE A. ~ The above information and tau due is correct. Resit payment to the Resister of Wills with two copies of this notice to obtain CHI=C K a discount or avoid interest, or check box "A" and return this notice to the Register of - Wills and an official assessment will be issued by the PA Departsent of Revenue. ONE B L(lC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Cosplete PA RT 2~ and/or PART ~ below. PART If indicating a different tax rate, please state `f:.'~ to decedent: hi ti l ~' ' a ons p re a TAX RE TURN - COMPUTATION OF TAX ;. ON JOINT/TRUST ACCOUNTS >' ~.. =. ~ LINE 1. Date Established 1 %%~ ` .. $ ~'~` "~' 2. Account Balance 2 ''-~~ H f X ~~~ ` ' 3. Percent Taxable 3 " ."':~ 11.r.'~' ~ ~ ' ./ . ' it .. ~ ~ ' 4. Amount Subject to Tax 4 :' f'` 5. Debts and Deductions 5 %~5"~~+ 6. Amount Taxable 6 $ '>`~~'~ . 7. Tax Rate 7 X sf ~°`'j" 8 Tax Due 8 $ '%s '~ ~ ~" . PART DEBTS AND DEDUCTIONS CLAIMED DATE P AID PAYEE DESCRIPTION AMOUNT RAID Undeii~ penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H 0 M E t ~ WORK TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax computations ~ ~~ PENNSYLVANIA INHERITANCE TAX t INFORMATION NOTICE ' BUREAU OF INDIVIDUAL TAXES A N D Po Box 2an6o1 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFV (00-OB) GRETCHEN L SCHUMAN 600 EAST MAPLE STREET MECHANICSBURG PA 17055 S pJ MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax dua. Records indicate that at tha dea#h of the above-named decedent, You were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to tha above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 78.1-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19342-00 Date 05-24-1977 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 1 , 963.92 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 327 • 33 months of the decedent's date of death, Tax Rate ~( ~ dl;j deduct a 5 percent discount on the tax due. Anv Inheritance Tax due will becowe delinquent Potential Tax Due $ 14 • 73 nine months after the date of death. PART TAXPAYER RESPONSE 0 .`~' ., ;;,:,: A. ~ The above information and tax duo is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ONE B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were vaid. Complete PART ~2 and/or PART l__.J below. PART If indicating a different tax rate, please state %~~ ~ f.q relationship to decedent: f >.f~ TAX RETURN - COMPUTATION OF TAX ; ON JOINT/TRUST ACCOUNTS , ~ '< . LINE 1. Date Established 1 Z. Account Balance 2 $ "~~ „~~ '~ ~' 3. Percent Taxable 3 X ~kr,,. ~~r" •'~,` . ~~ '~, `~ T t S t t 4 $ ~`>~ ~`` ~ ~ ~ 4. ubjec o ax Amoun ~ ~ I,, • '~ 5. Debts and Deductions 5 `%%; ~*~' ,,,~, ~ ' • F 6. A m o u n t T a x a b l e 6 $ l~r;"~ ~"` ~ ~"~^" ; -~~ • ''' 7. Tax Rate 7 ~" ~ •.,....:. ~ ~ ~;'. ,' ,<.• , 8. Tax Due 8 $ <,~.,y~: ~:~%"~: s~,:.. ,~•`~<~, f. ~. ~ xyz~%'y ~r,y~< ;~y~ '.%/:>.:;:.:r >. ,~<k::: '::c>x>: ~ r'.'v;:~Y~<~`::Sr:/ ' % PART DEBTS AND DEDUCTIONS CLAIMED a DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H 0 M E C WORK C TAXPAYER SIGNATURE TELEPHONE NI)MRFR nATC FILE N0. 21 10-0431 ACW 10125657 DATE 05-06-2010 TYPE OF ACCOUNT EST. OF KATHLEEN A ARMSTRONG ® SAVINGS SSN 162-22-3537 ~ CHECKING DATE OF DEATH 04 - 08 - 2010 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TOTAL CEnter on Line 5 of Tax Computation] 6 PENNSYLVANIA INHERITANCE INFORMATION NOTICE BUREAU OF INDIYIDWL TAXES A N D P(1 Box 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 * ~ * REVISED NOTICE ~ REY-1563 EX AFP (06-06> TYPE OF GLORIA J PHELPS 2 LARK ST MIDDLETOWN PA 17057 EST. OF KATHLEEN A ARMSTRONG SSN 162-22-3537 DATE OF DEATH 04-08-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ACCOUNT SAVINGS ® CHECKIN TRUST CERTIF. MEMBERS 1ST FCU provided the Depart~ent with the infor~ation below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-na~Red decedent, you were a joint owner/beneficiary of this account. If you feel the inforwatian is incorrect, please obtain written correction fro^ the financial institution, attach a copy to this forte and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cow~onwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19342-11 Date 12-06-1984 To ensure proper credit; to the account, two Established copies of this notice Ruust accoRapany payRaent to the Register of Wills Make check Account Balance $ 1 , 574.80 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTES If tax pay~ents are ^ade within three Amount Subject to TeX $ 262.47 R+onths of the decedent's date of death, TaX Rate X ~ gCFFj deduct a 5 percent discount on the tax due. Any Inheritance Tax due will becoRae delinquent Potential Tax Due $ 11 .81 nine wonths after the date of death. RT P TAXPAYER RESPONSE A 1 A. ~ The above infor~ation and tax due is correct. Resit pay~ent to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessaent will be issued by the PA DepartRaent of Revenue. ONE B LOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be file d by the estate representative. C. ~ The above inforRaa ion is incorrect and/or debts and deductions were paid. CoRaplete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state ` relationship to decedent: ; ~. w .. TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS pA `''~~ _ ~~' .. LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X ~ '~' 4 . ~ ,: ~ ~.~ ~; ~ 4. Amount Subject to Tax 4 ~ ~,. . - ~ ~ `_ 1 ` 5. Debts and Deductions 5 ~ \ $ u 6. Amount Taxable 6 ~ ~ , 7. Tax Rate 7 X ~•, ~~: ~ ~~ <. 8. Tax Due 8 $ ~' ~ ~ . " ~ PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ~ WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER neTF TAX FILE NO. 21 10-0431 ACN 10125660 * DATE 02-18-2011 TOTAL CEnter on Line 5 of Tax Computation) S PENNSYLVANIA INHERITANCE INFORMATION NOTICE • BUREAU OF INDIVIDUAL TAXES A N D Po aox 290601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 * ~ * REVISED NOTICE REV-1545 E% AFP (00-Y!) GLORIA J PHELPS 2 LARK ST MIDDLETOWN PA 17057 TAX FILE N0. 21 10-0431 ACN 10125660 * DATE 02-18-2011 TYPE OF EST. OF KATHLEEN A ARMSTRONG SSN 162-22-3537 DATE OF DEATH 04-08-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ACCOUNT SAVINGS ® CHECKINt TRUST CERTIF. MEMBERS 1ST FCU provided the Departwent with the inforwation below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-pawed decedent, you were a point owner/beneficiary of this account. If you feel the inforwation is incorrect. please obtain written correction frow the financial institution. attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cowwonwealth of Pennsylvania. Pleas¢ call 1717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19342- 1 1 Date 12- 06 - 1984 To ensure proper credit. to the account, two Established copies of this notice roust accowpany paywent to the Register of Wills. Make check Account Balance $ 1 , 574.80 payable to "Register of Wills. Agent". Percent Taxable X 16.667 NOTE: If tax vaywents are wade within three Amount Subject to Tax $ 262.47 wonths of the decedent's date of death, Tax Rate X . 045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will becowe delinquent Potential Tax Due $ 11 .81 nine wonths after the date of death. PART TAXPAYER RESPONSE A. ~ The above inforwation and tax due is correct. Rewit paywent to the Register of wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and re#urn this notice to the Register of wills and an official assesswent will be issued by the PA Departwent of Revenue. ONE B L 0 C K e. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above inforwa ion is incorrect and/or debts and deductions were paid. Cowplete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state ~ ~~~'~''~`~ relationship to decedent: ~: 2 ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS p ~~~~~~~ ~ ~- ~ ~~~ ~~~• LINE 1. Date Established 1 ` - .. :, ,. ,.. $ n \ 2 . Account Balance 2 ~~ ` ~ ~ ~~ ~ '-~ ,., , . X ,: 3. Percent Taxable 3 ~ ~~ ~ s ~ ~ ~ 4. Amount Subject to Tax 4 "A~ ,~ 5. Debts and Deductions 5 - ``, \~ :. - ' 6. Amount Taxable 6 ~~~ ~~~ .. `.~ 7. Tax Rate 7 X ~\ a~ :, 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H OM E C ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) 8 PENNSYLVANIA INHERITANCE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D Po BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 * ~ ~ REVISED NOTICE REV-)543 E% AFP f0a-t6) TAX FILE N0. 21 10-0431 ACN 10125658 * DATE 02-18-2011 TYPE OF ACCOUNT EST. OF KATHLEEN A ARMSTRONG ® SAVINGS SSN 162-22-3537 ~ CHECKIN DATE OF DEATH 04 - 08 - 2010 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYM ENT AND FORMS T0: REGISTER OF WILLS 1 COURTH OUSE SQUARE CARLISLE PA 17013 GLORIA J PHELPS 2 LARK ST MIDDLETOWN PA 17057 MEMBERS 1ST FCU provided the Department with the inforwation below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a ]oint owner/beneficiary of this account If you feel the infor~ation is incorrect, please obtain written correction frow the tinancial institution, attach a copy to this forte and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Con~wonwealth of Pennsylvania. Please call C717) 787-8327 with Questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Under penalties of perjury, I declare that the facts I have reported above are true, torte<:t and complete to the best of my knowledge and belief. HD ME C WORK C ~ TAXPAYER SIGNATURE TELEPHONE NIIMRFR Wert 10TAL (Enter on Line 5 of Tax Computation) $ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND E' I LE NO • 21 10 - 0431 Po Box 2Ba6o1 TAXPAYER RESPONSE ACN 10125658 HARRISBURG PA 17128-0601 * * * REVISED NOTICE ~ * * DATE 02-18-2011 REV-1563 EX AFP c®e-oe> GLORIA J PHELPS 2 LARK ST MIDDLETOWN PA 17057 TYPE OF ACCOUNT EST. OF KATHLEEN A ARMSTRONG ® SAVING SSN 162 - 22 - 3537 ~ CHECK IN DATE OF DEATH 04 - O8 - 2010 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 MEMBERS 1ST FCU provided the Departwent with the inforwation below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-Hawed decedent, you were a point ownerlbeneficiary of this account. If you feel the inforwation is incorrect, please obtain written correction frow the financial institution, attach a copy to this fort and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cowwonwealth of Pennsylvania. Please call C717) 787-8327 with questions, COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19342-00 Date 05-24-1977 To ensure vroper credit to the account, two Established copies of this notice west accowpany paywent to the Register of wills. Make check Account Balance $ 1 , 9b3.92 payable to ••Register of wills, Asent'•. Percent Taxable X 16.667 NOTE: If tax paywents are wade within three Amount Subject to Tax ~` 327.33 wonths of the decedent's date of death, Tax Rate ~( ~ 0!{~j deduct a 5 percent discount on the tax due. Any Inheritance Tax due will becowe delinquent Potential Tax Due $ 14.73 nine wonths after the data of death. PART TAXPAYER RESPONSE 0 ,, :.. `. A. ~ The above inforwation and tax des is correct. Rewit paywent to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assesswent will be issued by the PA Departwent of Revenue. ONE ~ L O C K B. ~ The above asset has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax return Q N L Y to be filed by the estate representative. C. ~ The above inforwa ion is incorrect and/or debts and deductions were paid. Cawplete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state ~ ~` '''~ ~~ ',~ a relationship to decedent: s .. TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS p ~ ~ ~ LINE 1. Date Established 1 ~ 2. Account Balance 2 $ ~~ `~` 3. Percent Taxable 3 X " $ ., \~ 'v. ~ ~. 4. Amount Subject to Tax 4 s ~~ 5. Debts and Deductions 5 ~ ~ ~~' ' .., 6. Amount Taxable 6 $ ~~ ~ ~ `\ X ~ S~ ~ 7. Tax Rate 7 ~ ,~ ?' ~°~` ~ c ~~ 8 . Tax Due 8 ~ ~ ~ ~ ~~ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ) WORK ( ) TAXPAYER SIGNATURE TELEPHC)NF NIIMAFR r-wYr_ TOTAL CEnter on Line 5 of Tax Computation) PENNSYLVANIA 1NHEK11ANl:E IAX -r INFORMATION NOTICE " BUREAU OF INDIVIDUAL TAXES A N D PO BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 D( AFP (00-OS) GRETCHEN L SCHUMAN b00 EAST MAPLE STREET MECHANICSBURG PA 17055 FILE N0. 21 10-0431 ACN 10125659 DATE 05-06-2010 TYPE OF ACCOUNT EST. OF KATHLEEN A ARMSTRONG ^ SAYINGS SSN 162 - 22 - 3537 ® CHECKING DATE OF DEATH o4-08-2o1n ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 MEMBERS 1ST FCU Provided the DepartMent with the infor~ation below, which has been used in calculating the potential tax due. Records indicate that at the death of the abovo-naaad decedent, you were a 3oint owner/beneficiary of this account. If you feel the information is incorrect, Please obtain written correction froN the financial institution, attach a copy to this fors and return it to th• above address. This account is taxable in accordance with the Inheritance Tax laws of the Co~~onwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19342-11 Date 12-06-1984 To ensure Proper credit 1:o the account, two Established COP1eS of this notice ^ust accoapany Pay~ent to the Register of Wills. Make check Account Balance 1 , 574 . $ 0 Payable to "Register of Wills, Agent". Percent Taxable X 16 .667 NOTE: If tax payeents are ^ade within three Amount Subject to Tax $ 262 • 47 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will beco~e delinquent Potential Tax Due ~ 11 • 81 nine months after the date of death. PART TAXPAYER RESPONSE 0 A. ^ The abovo infor~ation and tax due is correct. Resit payaent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of CHECK Wills and an official assesssent will be issued by the PA Department of Revenu®. ONE B L 0 C K B. ^ The above asset has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ^ The above infora~a ion is incorrect and/or debts and deductions were paid. Coaplete PA RT 2~ and/or PART 3^ below. PART If indicating a different tax rate, please state relationship to decedent: zf TAX RE TURN - COMPUTATIDN OF TAX ON JOINT/TRUST ACCOUNTS :> LINE 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ "~ ;• 5. Debts and Deductions 5 - ~~ 6. Amount Taxable b r: 7. Tax Rate 7 X 8. Tax Due 8 ~ ..> PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H 0 ME ~ ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE .. BUREAU OF INDIVIDUAL TAXES A N D Po Box 280601 TAXPAYER RESPONSE FWRRISBURG PA 17128-0601 REV-1543 EX AFP (00-00) FILE N0. 21 10-0431 ACN 10125b59 DATE 05-06-2010 GRETCHEN L SCHUMAN b00 EAST MAPLE STREET MECHANICSBURG PA 17055 TYPE OF ACCOUNT EST. OF KATHLEEN A ARMSTRONG ~ SAVINGS SSN 1b2-22-3537 ® CHECKING DATE OF DEATH 04 - OS - 2010 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a ]oint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Comwonwealth of Pennsylvania. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19342-11 Date 12-Ob-1984 To ensure proper credit 'to the account, two Established copies of this notice must accompany Account Balance $ 1 574 80 payment to the Register of Wills. Make check , . payable to "Register of Wills, Agent". Percent Taxable X 1 b .667 Amount Subject to Tax $ 2b2 47 NOTE: If tax payments ar•e made within three . months of the decedent's date of death, Tax Rate ~( ~ (~45 deduct a 5 percent discount on the tax due. Potential Tax Due $ 11 81 Any Inheritance Tax due will become delinquent . nine months after the date of death. P RT TAXPAYER RESPONSE A 1 A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue, 0 N E B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 311 below. PART If indicating a different tax rate, please state '~' ' ~ relationship to decedent: _:'~ ,, TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS '``3 ~~; LINE 1. Date Established 1 °~%r 2. Account Balance 2 $ 3. Percent Taxable 3 X 1 4. Amount Subject to Tax 4 $ ~-~ Y~v 5. Debts and Deductions 5 f., ~~• 6. Amount Taxable 6 $ ;f ., "~`~ , 7. Tax Rate 7 X $. ~'~ ^~ 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C WORK C TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE P BUREAU OF INDIVIDUAL TAXES A N D PO BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 a[v-ss4a oc ~•r cos-oes GRETCHEN L SCHUMAN 600 EAST MAPLE STREET MECHANICSBURG PA 17055 FILE N0. 21 10-0431 ACM 10125659 DATE 05-06-2010 BST. OF KATHLEEN A ARMSTRON SSN 162-22-3537 DATE OF DEATH 04-08-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 c1~~`,~ TYPE OF ACCOUNT C, ~ SAVINGS ® CHECKING TRUST CERTIF. MEMBERS 1ST F CU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 19342-11 Date 12-06-1984 To ensure proper credit •to the account, two Established copies of this notice must accospany payment to the Register of Wills. Make check Account Balance $ 1 , 574.80 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTES If tax payaents ar•e made within three Amount Subject to Tax $ 262 • 47 months of the decedent's date of death, Tax Rate ~( , p4rj deduct a 5 percent discount on the tax due. Any Inheritance Tax due will becowe delinquent Potential Tax DUe $ 11 • 81 nine months after the date of death. PART TAXPAYER RESPONSE 0 ~~ • A. ~ The above information and tax due is correct. Resit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ONE B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state ?' to decedent: hi ti l ~;'' a ons p re a TAX RE TURN - COMPUTATION OF TAX l lye:. ON JOINT/TRUST ACCOUNTS ~;~. LINE 1. Date Established 1 zf 2. Account Balance 2 ~ ~.. '~~ " 3. Percent Taxable 3 X >'% f ~ .`f9 "~ ~~{ ~~ 4. Amount Subject to Tax 4 , `, ~~., 5. Debts and Deductions 5 ~ "``;~` 6. Amount Taxable 6 $ ~"'" 7. Tax Rate 7 X '`~, sap` 8 Tax Due 8 $ '~~ "• " ' ' • . ~ is ~ q~.{y,: ,, y... ,.,;y .~.~~ yi y . ~y',,ivG ~ ~ •` ~'~, PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H 0 M E C WORK C TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on line 5 of Tax Computation) $ NENNSYLVANIA 1NHEK11ANl:E IAX INFORMATION NOTICE r ~' BUREAU OF INDIVIDUAL TAXES A N D PO Box 280601 TAXPAYER RESPONSE FL4RRISBURG PA 17128-0601 REY-)54b Elf AFP (00-08) FILE N0. 21 10-0431 ACN 10125662 DATE 05-06-2010 AMBER D SCHUMAN 600 E MAPLE STREET MECHANICSBURG PA 17055 TYPE OF ACCOUNT EST. OF KATHLEEN A ARMSTRONG ^ SAVINGS SSN 162 - 22 - 3537 ^ CHECKING DATE OF DEATH 04-08-2010 ^ TRUST COUNTY CUMBERLAND © CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decadent, you were a .ioint owner/benef:iciary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this forty and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 172459-40 Date 07-03-2003 To ensure proper credit t:o the account, two Established copies of this notice must accompany payment to the Register a~f Wills. Make check Account Balance $ 1 ~ 188 • 63 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTES If tax payments are made within three Amount Subject to Tax ~ 594.32 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 2b • 74 nine months after the date of death. PART TAXPAYER RESPONSE 1 A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtainn CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenu~a. BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ^ The above informs ian is incorrect and/or debts and deductions ware paid. Complete PART 2~ and/or PART 3^ below. PART If indicating a different tax rate, please state y~? `" relationship to decedent: '`~ a ~. TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS fir;;: .~ . LINE 1. Date Established 1 <r~ •. 2. Account Balance 2 $ ~~~, 3. Percent Taxable 3 X `;}~ ~; ':.::f.; ~ ;~ 4. Amount Subject to Tax 4 $ `y~~~%~: ~~~~" ., Na 5. Debts and Deductions 5 ~~~~ •~ ~. 6. Amount Taxable 6 $ <"`` ` ~~ ~ ~• .~: X hF,~ f.Y~ ~:~ Ci •+< 7. Tax Rate 7 '~`~ YiY~i:>/ ' 8 . Tax D u e 8 $ '><s~' •. ~ ~ `„' `~ ..~ ~ 'ii%' .•.f n<1.'r.... t:3`',.l•~ •f„ .~: ;:rf ' w%h:.i{SrF..>.,u: y'! ~: ,;.y. PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ~ WORK C TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S F'tMMIYLVAMlA 1MhtK11AMVt tAJI INFORMATION NOTICE ~- •` BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 10-0431 Po Box 2aobol TAXPAYER RESPONSE ACN 10125662 HARRISBURG PA 17128-Ob01 DATE 05-06-2010 REV-1543 EX AFP (00-00) AMBER D SCHUMAN 600 E MAPLE STREET MECHANICSBURG PA 17055 TYPE OF ACCOUNT EST. OF KATHLEEN A ARMSTRONG ^ SAVINGS SSN 162 - 22 - 3537 ^ CHECK ING DATE OF DEATH o4-os-2oln ^ TRUST COUNTY CUMBERLAND X^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 MEMBERS 1ST F CU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, You were a point owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the [:ommanwealth of Pennsylvania. Phase call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 172459-40 Date 07-03-2003 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 1 , 188.63 payable to "Register of wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to TaX $ 594.32 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due wall become delinquent Potential Tdx Due $ 26 • 74 nine months after the date of death. PART TAXPAYER RESPONSE ::::,; Ga A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ONE B L 0 C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ^ The above informs ian is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART 3^ below. PART If indicating a different tax rate, please state ~;..~~, •' %' Q relationship to decedent: "~%>;; ,~ r. j:~s.' t ~='' %~1~:: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS :', ._ t,. LINE 1. Date Established 1 3~~. 2. Account Balance 2 $ ~%, 3. Percent Taxable 3 ,,:.~ 4. AmOUnt SUbj@Ct t0 TaX 4 $ ::ti~•~'c; .'f%eY5'~.!!~;r,&i~rsr~'f:'%''u,'•',:y''~~~rv':1. y. • ~ /. :i' 5. Debts and Deductions 5 ~'~.:~; ;~:. 6. Amount Taxable 6 $ ~`~"&> ~ %. ,~'~ 7. Tax Rate 7 ~~~ N~ " 8. Tax Due 8 $ "`: y :/. ,.: ~~ x ti rQ~.l: f'.;'j:<:li:?~...'if.'~~~%.' :.:l4,.fl;':.}.';.::.:::r:,(.;'?';:;1..}•{',;/.%`::~E~'i.''./!g,.::¢'.:: i~p..:`:::k"•'!":::1.~: :~:/,. PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C WORK C TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S PENNSYLVANIA INHERITANCE TAX . ,~ INFORMATION NOTICE ~`~ BUREAU OF INDIVIDUAL TAXES A N D PO BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP (00-ed) FILE N0. 21 10-0431 ACN 10125662 DATE 05-06-2010 TYPE OF AMBER D SCHUMAN 600 E MAPLE STREET MECHANICSBURG PA 17055 EST. OF KATHLEEN A ARMSTRONG SSN 162-22-3537 DATE OF DEATH 04-08-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 c (D ACCOUNT SAVINGS CHECKING TRUST © CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attache a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C7173 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 172459-40 Date 07-03-2003 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 63 payment to the Register of Wills. Make check 1 188 ~ . payable to Register of Wills, Agent . Percent Taxable X 50.000 Amount Subject to NOTE: If tax payments are made within three Tax $ 594 32 . months of the decedent's date of death, Tax Rate ~( , a(~Gj deduct a 5 percent discount on the tax due. Potential Tax Due 2 6.7 4 Any Inheritance Tax due will become delinquent $ nine months after the dates of death. PART TAXPAYER RESPONSE 0 .:;,:. A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest. or check box "A" and return this notice to the Register of 0 N E Wills and an official assesswent will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PA RT 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state "'r'%y'~ relationsh ip to decedent • ,,~~y a:y, TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS `-'.:.< LINE 1 . Date Established 1 ~% s~ ~ `%;~;~ , : i ` • 2. Account Balance 2 $ ~ ~:~~ ~. .;r~: X 3. Percent Taxable 3 .. '~ f' •.G " 4. Amount Subject to Tax 4 $ '~''4r'r : ~ci.. rF "~`'~ r ~~'`::r~ "~'. r.r. r~: ~,~: 5. Debts and Deductions 5 `~, "~`~'~~ ~%%~`' j '• ~ 6. Amo u n t T a x a b l e 6 $ >~r' ~ .?Jf , ~ • 7. Tax Rats 7 X , ~f . •y : •, • ;., $ ~ ...`. ~. ry'.~ ` + . ,~~•.~•~,: Y ~ '. 8. Tax Due 8 . r F )iii: ~/Ysf ` A ;: fi ., :'F!.Y / ."k. ,U SS / ,5 .. PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ~ WORK C TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TDTAL CEnter on Line 5 of Tax Computation) S PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I LE NO . 21 10 - 0431 Po BOX 280601 TAXPAYER RESPONSE ACN 10125661 HARRISBURG PA 17128-0601 DATE 05-06-2010 REV-1543 IX AFP (00-OB) BROOKE N SCHUMAN 600 EAST MAPLE STREET MECHANICSBURG PA 17055 BST. OF KATHLEEN A ARMSTRON SSN 162-22-3537 DATE OF DEATH 04-08-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT (, ~ SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-Hamad decedent, You were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attarh a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 148241-40 Date 07-03-2003 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance ~` 1 r 004.95 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 502 • 48 months of the decedent's date of death, Tax Rate ~( ~ OC~rj deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due ~ 22.61 nine months after the date of death. PART TAXPAYER RESPONSE 0 ks A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box '"A" and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. ONE B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ Tha above informa ion is incorrect and/or debts and deductions were paid. Complete PA RT 2~ and/or PART 3LJ below. PART If indicating a different tax rate, please state "~" ' .4. ^ 2 relationship to decedent: ` ~5~,. r~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~'. :~. J'' LINE 1. Date Established 1 ~f, f ll,. ` 2. Account Balance 2 $ :; ~j 3. Percent Taxable 3 X <`%? ,:;,. , 4. Amount Subject to Tax 4 $ ;:•< ``~' /.' . 5. Debts and Deductions 5 `f f` y > 6. Amount Taxable 6 $ s ~%~ '~ 7. Tax Rate 7 X ~; ~ ~~~ ``~ ~ 8 . Tax Due 8 '' ' ' PART DEBTS AND DEDUCTIONS CLAIMED a DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C WORK C TAXPAYER SIGNATURE TELEPHONE NIIMRFR neTG TOTAL CEnter on Line 5 of Tax Computation) $ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D Po BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REY-1543 EX AFP [O6^OB) FILE N0. 21 10-0431 ACN 10125661 DATE 05-06-2010 TYPE OF BROOKE N SCHUMAN 600 EAST MAPLE STREET MECHANICSBURG PA 17055 EST. OF KATHLEEN A ARMSTRONG SSN 162-22-3537 DATE of DEATH a4-o8-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ACCOUNT SAVINGS CHECKING TRUST © CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint ownerfbeneficiary of this account. If you feel the information is incorrect, please obtain written correction frog the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Comwonwealth of Pennsylvania. Please call C7I7) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FIL.IN6 AND PAYMENT INSTRUCTIONS Account No. 14824 1-40 Date 07-03-2003 To ensure proper credit to the account, two Established copies of this notice must accompany Under penalties of perjury, L declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C WORK C TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) $ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE NO. 21 10-0431 PO BOX 280601 TAXPAYER RESPONSE ACN 1oi25661 HARRISBURG PA 17128.0601 DATE 05 - 0 6 - 2010 REV-1543 EX AFP t08-08) BROOKE N SCHUMAN 600 EAST MAPLE STREET MECHANICSBURG PA 17055 TYPE OF ACCOUNT EST. OF KATHLEEN A ARMSTRONG ^ savlN~s S$jQ 162-22-3537 ^ CHECKING DATE OF DEATH 04-08-2010 ^ TRUST COUNTY CUMBERLAND © CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ~~ MEM$E RS 1ST FCU provided the Departwent with the inforwation below, which has bean used in calculating the potential tax due. Records indicate that at the death of the above-Hawed decedent, You were a point owner/beneficiary of this account. If you feel the inforwation is incorrect, please obtain written correction frow the financial institution, attach a copy to this forty and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the I:owwonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE RE~/ERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 148241-40 Bate 07-03-2003 To ensure proper credit to the account, two Established copies of this notice roust accowparn paywent to the Register of Wills. Make check Account Balance ~` 1 ~ 004 • 95 vayable to "Register of W.ills;, Agent". Percent Taxable X 50 . D00 NOTES If tax paywents era wade within three AmOUnt Subject to Tax ~` 502 • 4g wonths of the decedent's date of death. Tax Rate ~( , Ot+~j deduct a 5 percent discount on the tax due. Any Inheritance Tax due will 6ecowe delinquent Potential Tax Due $ 22 • 61 nine wonths after the data of death. PART TAXPAYER RESPONSE 0 ~;~ A. ^ Tha above inforwation and tax dua is correct. Rewit paywent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of CHECK Wills and an official assesswent will be issued by the PA Departwent of Revenue, ONE B L 0 C K B. ^ Tha above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ^ The above inforwa ion is incorrect and/or debts and deductions were paid. Cowplete PART 2~ and/or PART 3^ below. PART If indicating a different tax rate, please state '' ""~ ` relationship to decedent: ~ Y'' }~r TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS `,,¢ LINE 1. Date Established 1 <, ' "~'~ 2. Account Balance 2 $ ,. ~.. <:y~:-:> ~ ~• 3. Percent Taxable 3 X . ~~ . ~ `~"~ ~ 4. Amount Subject to Tax 4 $ %'!" ~'~; 5. Debts and Deductions 5 - ~~~~ r . 6. Amount Taxable 6 $ f -'> ~ ,s 7. Tax Rate 7 X ~ ,~~~ f , yr ~ PART DEBTS AND DEDUCTIONS CLAIMED a DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H 0 ME C ) WORK C ) TAXPAYER SIGNATURE TFI FPNf1NG N~~MR~o T.r.- TOTAL CEnLer on L1ne S or iax t,ompuzatxvn~ ~ ~~ i MEMBERS 1St FEDERAL CREDIT UNION Send {nquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main Switchboard: (717) 697-1181 or (800) 283-2328 EZ Cali: (717) 697-4372 or (800) 283-4372 TDO: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 ESTATE OF KATHLEEN A ARMSTRONG C/O GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of ,Accounts 3 May 01, 2010 thru May 31, 2010 Account Number: 383380 Balances at a Glance: Checking: 9, os7 . s7 Savings: 5 . o0 Certificates: o . 00 Loans: o . 00 Money Management: o . 00 Swipe 5 YTD Reward: o . 00 Page: 1 of 2 CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance May 01 May 11 Balance Forward Deposit by Check 17,428.95 0.00 17,428.95 May 15 Withdrawal 606,1 16,822.80 May 24 Check 000095 Tracer 0014638783 563.00- 16,259.80 Processed Check - AMERICAN EXPRESS TYPE: ARC PMT ID: 9133133497 May 24 Check 000096 Tracer 0025030546 652.00- 15,607.80 Processed Check - CHASE TYPE: CHECK PYMT ID: 9200602070 May 24 Check 000093 Tracer 0003605572 4,740.00- 10,867.80 May 25 Wit~rawal ACH DELUXE CHECK 13.9 10,853.85 TYPE: CHECK/ACC . ID: 1410216800 CO: DELUXE CHECK May 25 Check 000097 Tracer 0020731294 516.00- 10,337.85 Processed Check - RETAIL SERVICES2 TYPE: CHECKPAYMT ID: 3000000014 DATA: 20100523040097650400 May 25 Check 000098 Tracer 0001182144 31..00- 10,306.85 May 25 Check 000094 Tracer 0001170268 40d. 00- 9,906.85 May 26 Check 000100 Tracer 0001156073 57.00- 9,849.85 May 26 Check 000099 Tracer 0001175300 98.00- 9,751.85 May 28 Check 000103 Tracer 0001350778 18.OQ 9,733.85 May 28 Check 000105 Tracer 0001350803 82.00- 9,651.85 May 28 Check 000113 Tracer 0001373878 585'. OQ 9,066.85 May 31 Deposit Dividend 0.100% 0.82 9,067.67 Annual Percentage Yield Earned 0. 100% from 05/01/2010 through 05/3 1/2010 Based on Average Daily Balance of 9, 602. 15 May 31 Ending Balance 9,067.67 CHECK SUMMARY Check # Amount Date Check # Amount_ Date 000093 4,740.00 May 24 000096 652.00 May 24 000094 400.00 May 25 000097 516.00 May 25 000095 563.00 May 24 000098 31.00 May 25 - - - Continued on following page - - - 4t Send Inquires to: s000 t.oulse DrNs Main Switchboard: EZ Call: (717) 697-1161 or (800) 283-2328 (717) 697-4372 or (800) 283-4372 May 01, 2010 thru May 31, 2010 • PO Box AO PA 17053 Mechanicsburg TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 Account Number: 383380 MEMBERS 1• „~•,,,,.,~,,,~„ , www.memberslst.org TeleBranch: (717) 795-6049 or (800) 237-7288 Page: 2 of 2 Check # Amount Date Check # Amount Date 000099 98.00 May 26 000105* 82.00 May 28 000100 57.00 May 26 000113* 585. X00 May 28 000103* 18.00 May 28 * Asterisk next to number indicates skip in number sequence 11 Checks Cleared for 7, 742. 00 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description May 15 606. 15 Withdrawal May 25 13.95 Withdrawal ACH 2 Withdrawals and Other Charges for 620. 10 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description May 11 17,428.95 Deposit by Check May 31 0.82 Deposit Dividend 2 Depos)ts and Other Cred)ts for 17, 429. 77 SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance May 01 Balance Forward 5.00 May 31 Ending Balance 5.00 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 0.00 0011 CHECKING 0.82 Total Year To Date Dividends Paid 0.82 NOTE: Total includes closed shares Add Your Photo For Security Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention Program to the next.. level. We are experiencing an increasen$ number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. ~~ MEMBERS 1St FEDERAL CREDIT UNION Send Inquires to: 5000 Loulae Drfve PO Box 40 Mechanicsburg, PA 17053 www.membenl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: {717} 697-4372 or (800} 283-4372 TDD: (717) 697-5312 or (800} 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 ESTATE OF KATHLEEN A ARMSTRONG C/O GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of Accounts 3 Jun 01, 2010 thru Jun 30, 2010 Account Number: 383380 Balances at a Glance: Checking: s, 553.21 Savings: 5.00 Certificates: o . 00 Loans: o.oo Money Management: o . 00 Swipe 5 YTD Reward: o . 00 Page: 1 of 2 CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Jun 01 Balance Forward 9,067.67 Jun 01 Check 000104 Tracer 0004834376 6.00 9,061.67 Jun 01 Check 000112 Tracer 0004845395 108.00- 8,953.67 Jun 01 Check 000101 Tracer 0004706368 125.00- 8,82$.67 Jun 01 Check 000107 Tracer 0004737542 156.00 8,672.67 Jun 01 Check 000106 Tracer 0004742381 190.00- 8,482.67 Jun 02 Check 000102 Tracer 0001498241 384.00- 8,098.67 Jun 02 Check 000109 Tracer 0001488167 453.00- 7,645.67 Jun 03 Check 000110 Tracer 0001187101 166.00- 7,479.67 Jun 04 Check 000111 Tracer 0001194025 180.00 7,299.67 Jun 04 Check 000114 Tracer 0001208162 941.00- 6,358.67 Jun 08 Check 000115 Tracer 0001505057 38.00- 6,320.67 Jun 08 Check 000116 Tracer 0001177297 50.00 6,270.67 Jun 10 Check 000117 Tracer 0027900753 32.00- 6,238.67 Processed Check - VERIZON ARC TYPE: CHECK PYMT ID: 2005022221 DATA: DATA Jun 14 Check 000118 Tracer 1601765959 43.00- 6,195.67 Processed Check - ECHOSTAR COMMUNI TYPE: DISHCKPYMT ID: 8882327118 Jun 15 Check 000120 Tracer 0122678273 94.00- 6,101.67 Processed Check - UGI UTILITIES TYPE: UTIL PMT ID: 231174060 Jun 17 Check 000108 Tracer 0001157304 11'1.00- 5,990.67 Jun 21 Deposit 900.00 6,890.67 Jun 23 Check 000124 Tracer 0001191154 30.00- 6,860.67 Jun 24 Check 000122 Tracer 0001171169 15.00- 6,845.67 Jun 24 Check 000121 Tracer 0001177110 34.00- 6,811.67 Jun 25 Check 000123 Tracer 0001577130 19.00- 6,792.6T Jun 28 Check 000119 Tracer 0004272341 240.00 6,552.67 Jun 30 Deposi# Dividend 0. 100% 0.54 6,553.21 Annual Percentage Yield Earned 0. 100% from 06/01/2010 through 06130/2010 Based on Average Dally Balance of 6,546. 34 Jun 30 Endfng Balance 6, 553.21 - - - Continued on following page - - - ~• Send Inquires to: 4t 5000 Louisa DrNe Maln Switchboard: (717) 697-1161 or (800) 283-2328 PO Box 40 EZ Call: (717) 697-4372 or (800) 283-4372 Jun 01, 2010 thru Jun 30, 2010 Mechanicsburg, PA 17055 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 Account Number: 383380 MEMBERS t•~ TeleBranch: (717) 795-6049 or (800) 237-7288 ,,.,~„µa,,,,„~,„ www.membersist.org Page' 2 of 2 CHECK SUMMARY Check # Amount Date Check # Amount Date 000101 125.00 Jun 01 000115 38.00 Jun 08 000102 384.00 Jun 02 000116 50.00 Jun 08 000104* 8.00 Jun 01 000117 32.00 Jun 10 000106* 190.00 Jun 01 000118 43.00 Jun 14 000107 156.00 Jun 01 000119 240.00 Jun 28 000108 111 .00 Jun 17 000120 94.00 Jun 15 000109 453.00 Jun 02 000121 34.00 Jun 24 000110 166.00 Jun 03 000122 15.00 Jun 24 000111 180.00 Jun 04 000123 19.00 Jun 25 000112 108.00 Jun 01 000124 30.00 Jun 23 000114* 941.00 Jun 04 * Asterisk next to number indicates skip /n number sequence 21 Checks Cleared for 3, 415. 00 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Jun 21 900.00 Deposit Jun 30 0.54 Deposit Dividend 2 Deposits and Other Credits for 900.54 SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS _Date Transaction Description Additions Subtractions Balance Jun 01 Balance Forward 5.00 Jun 30 Ending Balance 5.00 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 0011 CHECKING 0.00 1.36 Total Year To Date Dividends Paid NOTE: Total includes closed shares Add Your Photo For Security 1.36 Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasingg number of attempted fraudulent activities and as a result, we need to be able to verify your identtity immediately upon retrieving your account information. In addition to having your photo in our files, you may be regwired to show additional forms of identification based on the type of transaction you are seekingg. This is for your protection and security and we appreciate your ongoing cooperation and understanding. St MEMBERS Est FEI.)E:KA.1. C1ZF.D1'T IJNIOV' Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697 4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 ESTATE OF KATHLEEN A ARMSTRONG C!O GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of Accounts Jul 01, 2010 thru Juf 31, 2010 Account Number: 383380 Balances at a Glance: Checking: 4,155.86 Savings: 5.00 Certificates: 0.00 Loans: 0.00 Money Management: 0.00 Page: 1 of 2 Member Loyalty Rewards. Advice that saves you money. Please read the enclosed insert for more details. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Jul 01 Balance Forward 6,553.21 Jut 02 Withdrawal 1,000.00- 5,553.21 Jut 16 Check 000126 Tracer 0123728712 15.00- 5,538.21 Processed Check - UGI UTILITIES TYPE: UTIL PMT ID: 23117406 0 Jul 19 Check 000125 Tracer 0003148346 98.00- 5,440.21 Jul 19 Check 000129 Tracer 0003453683 869.20- 4,571.01 Jul 20 Check 000127 Tracer 0001195268 90.00- 4,481.01 Jut 20 Check 000128 Tracer 0001194017 100.00- 4,381.01 Jul 22 Check 000130 Tracer 0001193354 16.00- 4,365.01 Jul 23 Check 000131 Tracer 0001428505 83.00- 4,282.01 Jul 26 Check 000133 Tracer 0003931780 101.70- 4,180.31 Jul 29 Check 000135 Tracer 0001377387 1.81- 4,178.50 Jul 29 Check 000132 Tracer 0001373627 8.07- 4,170.43 Jul 29 Check 000134 Tracer 0001343392 15.00- 4,155.43 Jul 31 Deposit Dividend 0.100% 0.43 4,155.86 Annual Percentage Yield Earned 0.100% from 7/112010 through 7/31/2010 Based on Average Daily Balance of $5,047.23 Jul 31 Ending Balance 4,155.86 CHECK SUMMARY Check # Amount Date Check # Amount Date 000125 98.00 Ju119 000131 83.00 Ju123 000126 15.00 Ju116 000132 8.07 Ju129 000127 90.00 Ju120 000133 101.70 Ju126 000128 100.00 Ju120 000134 15.00 Ju129 000129 869.20 Ju119 000135 1.81 Ju129 000130 16.00 Ju122 11 Checks Cleared for $1,397.78 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Jul 02 1,000.00 Withdrawal 1 Withdrawals and Other Charges for $1,000.00 --- Continued on following page --- ;~ Send Inquires to: 5000 Louise Drive Main Switchboard: (717) 697-1161 or (800) 283-2328 Jul 01, 2010 thru Jul 31, 2010 Po sox ao EZ Call: (717) 697 4372 or (800) 283-4372 Account Number: 383380 ~tEJiBEttS t° Mechanicsburg, PA 1TQ55 TDD: (717} 697-5312 or (800) 283-2328 ext. 5312 ~~ `~"« ~~~~~~~'~ www.members1st.org TeleBranch: (717) 795-8049 or (800) 237-7288 Page: 2 Of 2 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description _ _ Jul 31 0.43 Deposit Dividend 0.100°l° 1 Deposits and Other Credits for 50.43 SAVINGS ACCOUNTS 0000 -REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Jul Ut Balance Forward 5.00 Jul 31 Ending Balance 5.00 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS $0.00 0011 CHECKING $1.79 Total Year to Date Dividends Paid 1 79 NOTE: Total includes closed shares S~ Send Inquires to: 5000 Louise Drive PO Sox 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: (717) 897-1161 or (800) 283-2328 EZ Call: (717) 897 4372 or (800) 283-4372 ~ TDD: (717) 897-5312 or (800) 283-2328 ext. 5312 MEMBERS 1st TeleBranch: (717) 795-8049 or (800) 237-7288 F>:t.»:n:~t. c:ur:r~rr t~niov ESTATE OF KATHLEEN A ARMSTRONG CIO GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of Accounts Aug 01, 2010 thru Aug 31, 2010 Account Number: 383380 Balances at a Glance: Checking: 3,322.21 Savings: 5.00 Certificates: 0.00 Loans: 0.00 Money Management: 0.00 Page: 1 of 2 Buying or building a home? Attend one of our FREE seminars! See the enclosed insert for more details. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Aug 01 Balance Forward 4,155.86 Aug 09 Check 000137 Tracer 0004344753 633.00- 3,522.86 Aug 16 Check 000136 Tracer 0003235913 4.44- 3,518.42 Aug 26 Check 000140 Tracer 0001169151 73.00- 3,445.42 Aug 26 Check 000139 Tracer 0001505661 100.00- 3,345.42 Aug 30 Deposit by Check 190.00 3,535.42 Aug 30 Withdrawal 200.00• 3,335.42 Aug 30 Check 000138 Tracer 0003638283 13.52- 3,321.90 Aug 31 Deposit Dividend 0.100°!0 0.31 3,322.21 Annual Percentage Yield Eamed 0.100% from 8/1/2010 through 8/31/2010 Based on Average Daily Balance of $3,648.92 Aug 31 Ending Balance 3,322.21 Check # Amount Date 000136 4.44 Auq 16 000137 633.00 Auq 09 000138 13.52 Auq 30 5 Checks Cleared for $$23.96 CHECK SUMMARY Check # Amount Date 000139 100.00 Aua 26 000140 73.00 Auq 26 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Aug 30 200.00 Withdrawal 7 Withdrawals and Other Charges for $200.00 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Aug 30 190.00 Deposit by Check Aug 31 0.31 Deposit Dividend 0.100% 2 Deposits and Other Credits for $190.31 SAVINGS ACCOUNTS --- Continued on foliowing page --- ~ Send Inquires to: 5000 Louise Drive Main Switchboard: (717) 697-1161 or (800) 283-2328 Aug 01 ~ 2010 thru Aug 31, 2010 PO Box 40 EZ Cail: (717) 897 4372 or (800) 283-4372 Account Number: 383380 AIENBFdts i~ Mechanicsburg, PA 17055 TOD: (717) 697-5312 or (800) 283-2328 ext. 5312 '~ `""~~"~"~"- www memberslst.org TeleBranch: (717) 795-6049 or (800) 23T-7288 Page: 2 of 2 0000 -REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Aug 01 Balance Forward 5.00 Aug 31 Ending 8a/ance 5.00 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS $0.00 0011 CHECKING $2.10 Total Year to Date Dividends Paid NOTE: Total inciudes closed shares 2.1 ~0 S~ Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main Switchboard: (717) 897-1161 or (800) 283-2328 EZ Call: (717) 897 4372 or (800) 283-4372 ~~ TDD: (717) 897-5312 or (800) 283-2328 ext. 5312 MEMBERS ~sl: TeleBranch: (717} 795-6049 or (800) 237-7288 FEI.)ERALC:R.F:I)l'1' UN!(:)V ESTATE OF KATHLEEN A ARM STRONG C/O GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of Accounts Sep 01, 2010 thru Sep 30, 2010 Account Number: 383380 Balances at a Glance: Checking: 2,449.20 Savings: 5.00 Certificates: 0.00 Loans: 0.00 Money Management: 0.00 Page: 1 of 2 Visit any of our branch locations on Thursday, October 21, 2010 and join us in celebrating International Credit Union Day. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Sep 01 Balance Forward 3,322.21 Sep 03 Check 000142 Tracer 0001362879 21.00- 3,301.21 Sep 03 Check 000141 Tracer 0001372884 401.98- 2,899.23 Sep 07 Check 000143 Tracer 0004757338 65.96- 2,833.27 Sep 17 Check 000144 Tracer 0001680216 1.48- 2,831.79 Sep 18 Deposit by Check 17.18 2,848.97 Sep 18 Withdrawal 200.00- 2,648.97 Sep 29 Withdrawal 200.00- 2,448.97 Sep 30 Deposit Dividend 0.100% 0.23 2,449.20 Annual Percentage Yield Earned 0.100% from 9/1/2010 through 9/30!2010 Based on Average Daily Balance of $2,78t.41 Sep 30 Ending Balance 2,449.20 CHECK SUMMARY Check # Amount Date 000141 401.98 Sea 03 000142 21.00 Sep 03 Check # Amount Date 000143 65.96 Sep 07 000144 1.48 Sep 17 4 Checks Cleared for $490.42 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Sep 18 200.00 Withdrawal Sep 29 200.00 Withdrawal 2 Withdrawals and Other Charges for $400.00 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Sep 18 17.18 Deposit by Check Sep 30 0.23 Deposit Dividend 0.100% 2 Deposits and Other Credits for $17.41 SAVINGS ACCOUNTS 0000 -REGULAR SAVINGS --- Continued on following page -- ,t Send Inquires to: 5000 Louise Drive Main Switchboard: (717) 697-1161 or (800- 283-2328 S@ 01, 2010 thru S@ 30, 2010 P P PO Box 40 EZ Ca{I: (717) 697 4372 or (800) 283-4372 Account Number: 383380 itf:St13tA5 i" ~"- Mechanicsburg, PA 17055 TDD: (717) 697-5312 or (800} 283-2328 ext. 5312 237 7288 0 Page: 2 of 2 " """°'„ ~ wvrw.members1st.org - 0) TeleBranch: (717) 795-6049 or (8 Date Transaction Descri tion Additions Subtractions Balance Sep 01 Balance Forward 5.00 Sea 30 Ending Balance 5.00 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS $0.00 0011 CHECKING $2.33 Total Year to Date Dividends Paid NOTE: Total includes closed shares 2.33 ~~ MEMBERS Est FE1.)FI2AI,CIt.Et)f3' t1~IC)V Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: {717) 697-1161 or (800) 283-2328 EZ Call: (717) 897 4372 or (800) 283-4372 7DD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeieBranch: (717) 795-6049 or (800) 237-7288 ESTATE OF KATHLEEN A ARMSTRONG C/O GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of Accc-unts Oct 01, 2010 thru Oct 31, 2010 Account Number: 383380 Balances at a Glance: Checking: 633.84 Savings: 5.00 Certificates: 0.00 Loans: 0.00 Money Management: 0.00 Page: 1 of 2 We make it EZ to transfer between financial institutions. See the enclosed insert for more details. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Oct 01 Balance Forward 2,449.20 Oct 13 Check 000145 Tracer 0010941656 452.00- 1,997.20 Processed Check -ERIE INSURANCE TYPE: 1256038677 ID: 1256038677 Oct 13 Check 000146 Tracer 0001406476 1,076.89- 920.31 Oct 16 Deposit by Check 13.53 933.84 Oct 16 Withdrawal 100.00- 833.84 Oct 23 Withdrawal 200.00- 633.84 Oct 31 Ending Balance 633.84 CHECK SUMMARY Check # Amount Date Check # Amount Date 000145 452.00 Oct 13 000146 1,076.89 Oct 13 2 Checks Cleared for $1,528.89 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Oct 16 100.00 Withdrawal Oct 23 200.00 Withdrawal 2 Withdrawals and Other Charges for $300.00 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Oct 16 13.53 Deposit by Check 1 Deposits and Other Credits for $13.53 SAVINGS ACCOUNTS 0000 -REGULAR SAVINGS Date Transaction Description Additions Subtractions _ i3alance Oct 01 Balance Forward 5.00 Oct 31 Ending Balance 5.00 --- Continued on following page --- ~ ~ Send Inquires to: 5000 Louise Drive Maln Switchboard: (717) 697-1161 or (800) 283-2328 OCt 01, 2010 thru Oct 31, 2010 PO Box 40 EZ CaN: (717) 697 4372 or (800) 283-4372 Account Number: 383380 ~tE4tBFRS t° Y Mechanicsburg, PA 17055 TDD: (717) 897-5312 or (800) 283-2328 ext. 5312 ~~ ~""~ „~~~~~~ www memberslst.org TeleBranch: _ (717) 795-6049 or (800) 237-7288 Page: 2 of 2 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS $0.00 0011 CHECKING $2.33 Total Year to Date Dividends Paid NOTE: Total includes closed shares 2.33 ~~ t~) MEMBERS lst FEl)F.It111,C:FtEi)i'l' UNION Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Cali: (717} 697 4372 or (800) 283-4372 TDD: (717) 897-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 ESTATE OF KATHLEEN A ARMSTRONG C!O GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of Accounts Nov 01, 2010 thru Nov 30, 2010 Account Number: 383380 Balances at a Glance: Checking: 99,375.07 Savings: 5.00 Certificates: 0.00 Loans: 0.00 Money Management: 0.00 Page: 1 of 2 Need the perfect gift for someone on your gift list? Give them a Visa Prepaid Gift Card. For more information visit ~~~ww.members 1 st.org/VisaGiftCards.aspx. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Nov 01 Balance Forward 633.84 Nov 08 Check 000147 Tracer 0001224256 97.65- 536.19 Nov 20 Deposit by Check 332.00 868.19 Nov 20 Withdrawal 300.00- 568.19 Nov 22 withdrawal 300.00- 268.19 Nov 22 Deposit by Check 100,200.39 100,468.58 Nov 24 Withdrawal 1,000.00- 99,468.58 Nov 26 Check 000150 Tracer 0124302752 32.00- 99,436.58 Processed Check - UGI UTILITIES TYPE: UTIL PMT ID: 231174060 Nov 26 Check 000149 Tracer 0001411012 21.00- 99,415.58 Nov 26 Check 000148 Tracer 0001406020 43.00- 99,372.58 Nov 30 Deposit Dividend 0.100% 2.49 99,375.07 Annual Percentage Yield Earned 0.100% from 11/1/2010 through 11/30/2010 Based on Average Daily Balance of $30,291.49 Nov 30 Ending Balance 99,375.07 CHECK SUMMARY Check # Amount Date 000147 97.65 Nov 08 000148 43.00 Nov 26 4 Checks Cleared for $193.65 Check # Amount Date 000149 21.00 Nov 26 000150 32.00 Nov 26 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Nov 20 300.00 Withdrawal Nov 24 1,000.00 Withdrawal Nov 22 300.00 Withdrawal 3 Withdrawals and Other Charges for $1,600.00 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Nov 20 332.00 Deposit by Check Nov 30 2.49 Deposit Dividend 0.100% Nov 22 100,200.39 Deposit by Check --- Continued on following page -- gt Send Inquires to: 5000 Louise Drive Main Switchboard: (717) 897-1161 or (800) 283-2328 Nov 01, 2010 thru Nav 30, 2010 PO Box 40 EZ Calt: (717) 697 4372 or (800) 283-4372 Account Number: 383380 ~tES1BEsR5,1- * Mechanicsburg, PA 17055 TDD: (717) 697-5312 or (600) 283-2328 ext. 5312 ~~ ~~~ ~~~~` ~~ www members1st.org TeleBranch: (717) 795-6049 or {800) Z37-7288 Page: 2 of 2 3 Deposits and Other Credits for 6100,534.88 SAVINGS ACCOUNTS 0000 -REGULAR SAVINGS Date Transaction Descriation Additions Subtractions Balance Nov 01 Balance Forward 5.00 Nov 30 Ending Balance 5.00 YTD SUMMARIES TOTAL DIV{DENDS PAID 0000 REGULAR SAVINGS $0.00 0011 CHECKING $4.82 Total Year to Date Dividends Paid NOTE: Total includes closed shares 4.82 S~ Send Inquires to: 5000 Louise Drive PO Boz 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call; (717) 697 4372 or (800) 283-4372 ~~ TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 MEMBERS ~st releBranch: (717) 795-6049 or (800) 237-7288 i~>:r~Ettai.c:trkt~r~r u~rov ESTATE OF KATHLEEN A ARMSTRONG C/O GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of Accounts Dec 01, 2010 thru Dec 31, 2010 Account Number: 383380 Balances at a Glance: Checking: 46,245.65 Savings: 5.00 Certificates: 0.00 Loans: 0.00 Money Management: 0.00 Page: 1 of 2 1099-TNT's are not included in this statement. If you earned at least $10 in dividends on your account for 2010, you will receive your 1099-INT in a separate mailing in early January 2011. 1099-INT information will also be available on Members 1st Online early in January. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Dec 01 Balance Forward 99,375.07 Dec 03 Withdrawal 6,916.66- 92,458.41 VISA PAYOFF Dec 04 Withdrawal 800.00- 91,658.41 Dec 07 Check 000154 Tracer 0001460359 214.00- 91,444.41 Dec 08 Check 000153 Tracer 0001173331 8.00- 91,436.41 Dec 09 Check 000152 Tracer 0001145100 12.00- 91,424.41 Dec 10 Check 000151 Tracer 0124357954 35.00- 91,389.41 Processed Check - UGI UTILITIES TYPE: UTIL PMT ID: 231174 060 Dec 15 Check 000155 Tracer 0001774556 150.00- 91,239.41 Dec 17 Check 000156 Tracer 0001840533 15,000.00- 76,239.41 Dec 20 Check 000157 Tracer 0001186875 15,000.00- 61,239.41 Dec 21 Check 000158 Tracer 0001173560 15,000.00- 46,239.41 Dec 31 Deposit Dividend 0.100% 6.24 46,245.65 Annual Percentage Yield Earned 0.100% from 12/1/2010 through 12/31/2010 Based on Average Daily Balance of $73,500.19 Dec 31 Ending Balance 46,245.65 CHECK SUMMARY Check # Amount Date Check # Amount Date 000151 35.00 Dec 10 000155 150.00 Dec 15 000152 12.00 Dec 09 000156 15,000.00 Dec 17 000153 8.00 Dec 08 000157 15,000.00 Dec 20 000154 214.00 Dec 07 000158 15,000.00 Dec 21 8 Checks Cleared for $45,419.00 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Dec 03 6,916.66 Withdrawal Dec 04 800.00 Withdrawal _ 2 Withdrawals and Other Charges for $7,716.66 --- Continued on fo{iowing page --- Send Inquires to: 5000 Louise Drive Main Switchboard: (717) 697-1181 or {800) 283-2328 D@C 01, 2010 thru Dec 31, 2010 Po Box ao EZ Call: (717) 897 4372 or (800) 283-4372 Account Number: 383380 ~tE1tBE.tts I", Mechanicsburg, PA 17055 TOD: {717) 697-5312 or {800) 283-2328 ext. 5312 """"""'~~"" www.memberslst.org TeleBranch: (717) 795-6049 or (S00) 237-7288 Page: 2 of 2 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Dec 31 6.24 Deposit Dividend 0.100°!° 7 Deposits and Other Credits fnr 66.24 SAVINGS ACCOUNTS 0000 -REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Dec 01 Balance Forward 5.00 Dec 31 Ending Balance _ _ _ 5.00 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS $0.00 0011 CHECKING $11.06 Total Year to Date Dividends Paid 11.OEi NOTE: Total includes closed shares St MEMBERS 1St FEDERAL CREDIT UNION Send Inquires to: 5000 Loulae Drlve PO Box 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 ESTATE OF KATHLEEN A ARMSTRONG C/O GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of Accounts 3 Nov 01, 2010 thru Nov 30 , 2010 Account Number: 383380 Balances at a Glance: Checking: 99, 375 . of Savings: 5.00 Certificates: o . 00 Loans: o . 00 Money Management: o . 00 Swipe 5 YTD Reward: o . 00 Page: 1 of 2 CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Nov 01 Ba/ance Forward 633.84 Nov 08 Check 000147 Tracer 0001224256 97.65- 536. 19 Nov 20 Deposit by Check 332.00 868. 19 Nov 20 Withdrawal 300.00- 568. 19 Nov 22 Withdrawal 300.00- 268. 19 Nov 22 Deposit by Check 100,200.39 100,468.58 Nov 24 Withdrawal 1,000.00- 99,468.58 Nov 26 Check 000150 Tracer 0124302752 32.00- 99,436.5$ Processed Check - UGI UTILITIES TYPE: UTIL PMT ID: 231174060 Nov 26 Check 000149 Tracer 0001411012 21.00- 99,415.58 Nov 26 Check 000148 Tracer 0001406020 43.00- 99,372.58 Nov 30 Deposit Dividend 0. 100% 2.49 99,375.07 Annual Percentage Yield Earned 0. 100% from 11/01/2010 through 11/30/2010 Based on Average Daily Balance of 30, 291.49 Nov 30 Ending Ba/ance 99,375.07 CHECK SUMMARY Check # Amount Date Check # Amount Date 000147 97.65 Nov 08 000149 21.00 Nov 26 000148 43.00 Nov 26 000150 32.00 Nov 26 4 Checks Cleared for 193. 65 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Nov 20 300.00 Withdrawal Nov 24 1,000.00 Withdrawal Nov 22 300.00 Withdrawal 3 Withdrawals and Other Charges for 1, 600. 00 - - - Continued on following page - - - • st Send Inquires to: Main Switchboard: (717) 697-1161 or (800) 283-2328 5000 Louise Drfve ~ Call: (717) 697-4372 or (800} 283-4372 Po Box ao Nov 01, 2010 thru Nov 30, 2010 Mechanicsburg, PA 17055 ADD' (717) 697-5312 or (800) 283-2328 ext. 5312 ~ Account Number: 383380 ?eleBranch: (717) 795-6049 or (800} 237-7288 MEMBERS 1" ,~,,,,~,.q,,,,,„o„ www.memberslst.org Page' 2 Of 2 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Nov 20 332.00 Deposit by Check Nov 30 2.49 Deposit Dividend Nov 22 100,200.39 Deposit by Check 3 Deposits and Other Credits for 100, 534. 88 SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Nov 01 Balance Forward 5.00 Nov 30 Ending Balance 5.00 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 0.00 0011 CHECKING 4.82 Total Year To Date Dividends Paid 4.82 NOTE: Total includes closed shares Add Your Photo For Security Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly. encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. • St MEMBERS 1St FEDERAL CREDIT UNION Send Inquires to: 5000 Loufse Drive PO Boz 40 Mechanlcaburg, PA 17055 www.membersl at.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800} 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 ESTATE OF KATHLEEN A ARMSTRONG C/O GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of Accounts 3 Oct 01 , 2010 thru Oct 31, 2010 Account Number: 383380 Balances at a Glance: Checking: 633.84 Savings: 5.00 Certificates: o . 00 Loans: o . 00 Money Management: o . 00 Swipe 5 YTD Reward: o . 00 Page: 1 of 2 CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions Subtractions Balance Oct Ot Balance Forward 2,449.20 Oct 13 Check 000145 Tracer 0010941656 452.00- 1,997.20 Processed Check - ERIE INSURANCE TYPE: 1256038677 I D: 1256038677 Oct 13 Check 000146 Tracer 0001406476 1,076. 89- 920.31 Oct 16 Deposit by Check 13.53 933.84 Oct 16 Withdrawal 100.00- 833.84 Oct 23 Withdrawal 200.00- 633.84 Oct 31 Ending Balance 633.84 CHECK SUMMARY Check # Amount Date Check # Amount Date 000145 452.00 Oct 13 000146 1, 076.89 Oct 13 2 Checks Cleared for 1, 528. 89 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Oct 16 100.00 Withdrawal Oct 23 200.00 Withdrawal 2 Withdrawals and Other Charges for 300.00 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Oct 16 13.53 Deposit by Check SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS _Date Transaction Description Additions Subtractions Balance Oct 01 Balance Forward 5.00 - - - Continued on following page - - - Send Inqu+res to: St Maln Switchboard: (717) 697-1161 or (800) 283-2328 5000 Louise Drive ~ call: (717) 697-4372 or (800) 283-4372 Oct 01, 2010 thru Oct 31, 2010 PO Box 40 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 • Mechanicsburg, PA 17055 Account Number: 383380 MEMBERS 1" TeleBranch: (717) 795-6049 or (800) 237-7288 „~.,,~.~~.o. www.memberslst.org Page' 2 Of 2 Date Transaction Description Additions Subtractions Balance Oct 31 Ending Balance 5.00 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 0.00 0011 CHECKING 2.33 Total Year To Date Dividends Paid 2.33 NOTE: Total includes closed shares Add Your Photo For Security Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasingg number of attempted fraudulent activities and as a result, we need to be able to verify your idenfity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you.are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. St MEMBERS 1St FEDERAL CREDIT UNION Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeieBranch: (717) 795-6049 or (800) 237-7288 ESTATE OF KATHLEEN A ARMSTRONG C/O GWENDOLYN S PHELPS 233 S ENOLA DRIVE ENOLA PA 17025 Statement of Accounts 3 Sep 01, 2010 thru Sep 30, 2010 Account Number: 383380 Balances at a Glance: Checking: 2,449.20 Savings: 5.00 Certificates: o . 00 Loans: o.oo Money Management: o . 00 Swipe 5 YTD Reward: o . 00 Page: 1 of 2 CHECKING ACCOUNTS 0011 - CHECK{NG Date _ Transaction Description Additions Subtractions Balance Sep 01 Balance Forward 3,322.21 Sep 03 Check 000142 Tracer 0001362879 21.00- 3,301.21 Sep 03 Check 000141 Tracer 0001372884 401.98- 2,899.23 Sep 07 Check 000143 Tracer 0004757338 65.96- 2,833.27 Sep 17 Check 000144 Tracer 0001680216 1.48- 2,831.79 Sep 18 Deposit by Check 17. 18 2,848.97 Sep 18 Withdrawal 200.00- 2,648.97 Sep 29 Withdrawal 200.00- 2,448.97 Sep 30 Deposit Dividend 0. 100% 0.23 2,449.20 Annual Percentage Yield Earned 0. 100% from 09/01/2010 through 09/30/2010 Based on Average Daily Balance of 2, 781.41 Sep 30 Ending Balance 2,449.20 CHECK SUMMARY Check # Amount Date Check # Amount Date 000141 401 .98 Sep 03 000143 65.96 Sep 07 000142 21 .00 Sep 03 000144 1.48 Sep 17 4 Checks Cleared for 490.42 WITHDRAWALS AND OTHER CHARGES Date Amount Description Date Amount Description Sep 18 200.00 Withdrawal Sep 29 200.00 Withdrawal 2 Withdrawals and Other Charges for 400. 00 DEPOSITS AND OTHER CREDITS Date Amount Description Date Amount Description Sep 18 17.18 Deposit by Check Sep 30 0.23 Deposit Dividend 2 Deposits and Other Credits for 17.41 - - - Continued on following page - - - at St Send inquires to: Maln Switchboard: (717) 697-1161 or (800) 283-2328 5000 Louise Drlve ~ Call: (717) 697-4372 or (800) 283-4372 Sep 01, 2010 thru Sep 30, 2010 PO Box 40 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 PA 17055 Mechanicsburg ~ Account Number: 383380 , TeleBranch: (717) 795-6049 or (800) 237-7288 MEMBERS 1° ,~..~n.~.~~. www.memberslst.org Page' 2 of 2 SAVINGS ACCQUNTS 0000 - REGULAR SAVINGS Date Transaction Descri tion Additions Subtractions Balance Sep 01 Balance Forward 5.00 Sep 30 Ending Balance 5.00 YTD SUMMARIES TOTAL DIV{DENDS PAID 0000 REGULAR SAVINGS 0.00 0011 CHECKING 2.33 Total Year To Date Dividends Paid 2.33 NOTE: Total includes closed shares Add Your Photo For Security Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our . branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next ievei. We are experiencing an increasingg number of attempted fraudulent activities and as a result, we need to be able to verify your idenfity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you_are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. s ` Estaste of Kathleen Armstrong Profit & Loss January through December 2010 Jan -Dec 10 Ordinary Income/Expense Income Refunds Sale of House Total Income Expense 1800 Got Junk American Express Apria Aziz Khan Boscovs Cardio Vascular Center for Disease Center for Kidney Central PA Pulmonary Chase Craig Anderson CW Fritz Deluxe Check Dish Network Erie Funeral Costs Heritage Med Holy Spirit Hospital Home Paramount inspection for House Internists of Central PA Lower Allen Township Lung Asthma Mobile Xray OGI Orthopedic Institute of PA PA American Water PPL Prism Probate Costs Quantum Registrar WiNs Sel{ing Costs Smith Radiology UGI Verizon Visa West Shore EMS West Shore Pathology Tota! Expense Net Ordinary Income Other Income/Expense Other Income Interest Total Other Income 2,179.44 131,900.00 134, 079.44 1,000.00 563.00 125.00 156.00 516.00 19.00 8.07 384.00 82.00 652.00 330.00 503.68 13.95 43.00 452.00 5,373.00 453.00 1,231.00 869.20 100.00 30.00 1,965.54 111.00 1.81 15.00 6.00 130.34 345.96 68.00 400.00 166.00 15.00 17,235.27 5.92 245.47 32.00 6,916.66 394.00 38.00 40,995.87 93,083.57 11.06 11.06 Page 1 s Estaste of Kathleen Armstrong Profit & Loss January through December 2010 Jan -Dec 10 Other Expense Distributions G Phelps G Shuman Gloria Phelps Total Distributions Total Other Expense Net Other Income Net Income 17, 800.00 15, 500.00 24,477.93 57, 777.93 57, 777.93 -57, 766.87 35,316.70 Page 2